FROM DISASTER TO DISTINC TION

The Health and Safety Transformation at Rio Tinto

“ Imeet
find it incredibly powerful that if I
with the Prime Minister of an
emerging country, I can say that we
will use the same employee health and
safety standards as we do in Australia,
the U.S. or Canada. It is very hard for
someone to compete with that.
TOM ALBANESE
”
C h i e f E x ec u t i v e O f f i ce r
R i o T i nto G r o u p
OVERVIEW
The mine in Lassing, Austria began to collapse on the
morning of July 17, 1998. Mud and debris fell into the pit,
trapping 24-year-old miner Georg Hainzl 60 metres below
ground. Hainzl made brief contact with a rescue team by
telephone. Then the line went dead.
Later in the day, as part of the rescue effort, ten other workers
were sent down to prop up the mine’s shafts. They were
working at a depth of 130 metres when a second, massive cave-
in began. This collapse was so extensive that entire houses
slowly slid into the mine. By nightfall, it had become a giant
crater. All ten men, who had not been ordered to the surface,
were trapped.
After more than a week of frantic effort, Hainzl was
miraculously found alive and rescued. The ten other trapped
miners were not so lucky.
Owned by Rio Tinto and operated by subsidiary Naintsch
Mineralwerke, the magnesium silicate mine where this tragedy
occurred had been considered Austria’s safest. The Lassing
incident was the single worst accident Rio Tinto had ever
experienced, and one of the most horrific in Europe since
World War II. Rio Tinto’s earnings dropped by roughly 10%
that year, its long-time chairman retired, and labour unions
and protestors marched on its headquarters in London,
accusing the company of human rights violations. The
situation was dire.
Yet barely a decade later, Rio Tinto would become the
industry leader in worker safety. And Rio Tinto’s mines in
Austria, the site of the 1998 tragedy, were officially named
some of the safest in all of Europe. This is the story of that
transformation.
FROM DISASTER TO DISTINCTION
The Health and Safety Transformation at Rio Tinto

CHALLENGE over the decades, but absolute numbers of both

injuries and deaths were still far from trivial. Rio Tinto
Mining has long been recognised as inherently
clearly sought to improve; even before the tragedy in
dangerous. As early as 1840, the Government of the
Austria, the firm had adopted a “No Fatalities” objective
United Kingdom commissioned a study on mining
and introduced enhanced NOSA (National Occupational
safety and concluded that, “accidents, brutality, lung
Safety Association) safety solutions in some of its
diseases, long hours, and highly dangerous and adverse
operations.1 But improvements were incremental; the
working conditions were found to be the norm.” At
mindset and behaviour of managers and staff had
the turn of the twentieth century, thousands of miners
remained unchanged for years. Safety was important,
were dying and nearly 100,000 were injured each year
of course, but there was an assumption that everything
in the United States alone. As recently as 1987, mining
that could be done was already being done.
continued to be the most dangerous industry in seven
out of eight European countries—often by far. Additionally, Rio Tinto was a large, siloed organisation.
The company had grown quickly through acquisitions,
By the late 1990s, when the miners died at Lassing,
and the different business units did not communicate
there was already a long-standing awareness of the
well. An incident at one mine would result in strong
need for safety precautions, both within Rio Tinto and
awareness at that particular site—and its workers
throughout the industry. As with occupational injuries
would rarely repeat that same mistake. However,
in general, mining safety had improved considerably

Overall Fatality Rate (OECD Fatality Index) by Industry

1985–1987
1,200

1,000
OECD Fatality Index

800

600

400

200

Canada Finland France Germany New Zealand Portugal Spain Sweden UK US

Mining Construction Transport Agriculture Power / Water Average, All Industries

All data use the OECD overall fatality rate index, a system of scoring safety performance across countries. For each nation, data are shown for
the two industries with the highest rate, along with the average rate across all industries. Source: OECD (1987)

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since no formal, company-wide mechanism existed improving safety throughout the company was a moral
to aggregate those lessons, different operational sites imperative and good for business, the new Chairman
throughout the company would continue to suffer told shareholders:
accidents and fatalities for the same reasons, year after

“
year. Our priority now is to intensify our long-standing efforts
Rio Tinto was not learning from its mistakes. And, to make our operations safe for all who work in them…
on average, between 8 and 12 miners were dying Our goal is to set the industry benchmark of performance
annually.
”
in all aspects of our operations.

Rio Tinto engaged the world’s recognised leaders in

RESPONSE
corporate safety, including DuPont. After extensive
The Lassing disaster convinced Rio Tinto’s top
study of the conditions and risks at Rio Tinto sites, the
leadership of the urgency of change. Recognising that
company’s leadership developed worldwide safety
standards that all Rio Tinto plants—whether operated
directly by Rio Tinto or by a contractor or subsidiary
—would be expected to follow. These documents
represented the first time that Rio Tinto ever
implemented a company-wide set of safety standards.

“ The secret was that Rio’s standards defined the ‘what’

but didn’t specify the ‘how.’ The isolation standards,
for example, might say that before you get on a piece
of equipment you have to put your personal lock on it,
to ensure the control of energy, and you have to test it
safely. But Rio wouldn’t tell a business unit how that
was to be done. The standards left flexibility to adapt to
conditions.2
”
The new standards and procedures comprised three
overarching management areas: general safety systems,
change management, and contractor management.
There were now eight specific activity standards, based
on the circumstances involved in most accidents:
isolation, electrical safety, vehicles and drilling, working
at heights, confined spaces, use of cranes and lifting
equipment, working underground, and molten

FROM DISASTER TO DISTINCTION | 4

materials handling. Significantly, these first standards
were essentially basic safety checklists, rather than
thick procedural manuals. This made them easy to
understand and implement in sites throughout the
company.

Rob Davies, a Rio Tinto safety advisor when the

initiative started, explains:

“ We realised very quickly that there are really only seven

or eight ways that workers can die at a mining site,
and that for each of those categories of risk, there were
only four or five specific safety procedures that our sites
needed to have in place to protect our workers. So those
first standards were very simple and straightforward
controls that we believed all of our operations sites could
and should implement.
”
The company also developed and implemented
new performance audits. These audits did not
simply measure the number of incidents at each site,
which would have been misleading due to the low-
probability, high-impact nature of mining accidents.
Instead, audit teams directly and personally measured
compliance with the new safety procedures – and they
did so in a way that matched the procedures’ simplicity:

“ The first audits were also rather straightforward. The

questions we asked were simple and the answers were
also simple and binary. We asked questions such as,
‘Do workers on your site wear a seatbelt while driving a
truck?‘ or ‘Do workers consistently use harnesses when
working at an elevated height?’3
”
Crucially, the audits were based on primary source data;
rather than asking a manager to answer questions on
behalf of his site, Rio Tinto sent auditors to study the
conditions first-hand.

FROM DISASTER TO DISTINCTION | 5

PUSHBACK safety. Executives also used several tools to convince
operations managers that these new standards were
With some exceptions, operations managers were
not going away—and that the audits had teeth.
generally unenthusiastic about the reforms. Many
perceived the new standards to be needless,
bureaucratic responses to horrible but extremely low-
probability events. Most assumed the new attention to
safety was a headquarters initiative that would quickly
“ The CEO set up the course of action around the global
standards and assurance processes that clearly held
leaders far more accountable for the safe operation of
pass—and therefore didn’t merit prioritisation relative
to other goals.
their mines or processing plants.5
”
But it didn’t end there. For example, performance audits

“ Quite a few operations managers looked at our first

safety standards and did make changes, but there were
just as many that thought, ‘This is a passing fad that
will be forgotten 12—18 months from now and that
went directly to the CEO, who did not take poor results
lightly. In some cases, managers were relieved of duty if
their sites did not improve enough by the second round
of audits. Audit performance was tied to monetary

”
therefore isn’t a real priority.’ 4

Some managers reacted even more strongly. They were

bonuses, and top performers were systematically
promoted. Outstanding sites received standing
ovations, awards, and other forms of high praise.
incredulous that in addition to meeting tight deadlines
and keeping down costs, they now had to enforce
time-consuming safety standards and procedures that
provided few obvious, direct benefits. Others remained
in a state of denial, believing that seemingly mundane
“ Many operations managers didn’t really believe that the
company would do a second round of audits, because
they didn’t think the senior leadership was really
procedures such as wearing seatbelts and harnesses committed to these changes. So it took them by surprise
did not require the consistent attention of busy when we did a second round of audits—and it surprised
supervisors—even when initial audits proved that their them even more that those audits went all the way to
workers were not in compliance. the CEO, who took them seriously. The CEO was
serious, so senior executives got serious, and eventually,
In the first years after Lassing, the sites’ adoption of the individual operations managers realised that this was

”
new standards was uneven and inconsistent. something they had to take seriously as well.6

PERSISTENCE, INSISTENCE, AND Operational leaders slowly began to realise that, like
SYSTEMATIC IMPROVEMENT it or not, Rio Tinto’s new approach to safety was not
going away—and that it was in their best interest to
Rio Tinto’s senior leadership was persistent. First, the
comply. Once they did, incident rates began to drop
CEO personally and publicly set ambitious annual goals
dramatically.
for company-wide accident reduction, sending a clear
message that the group’s leadership was serious about

FROM DISASTER TO DISTINCTION | 6


Interestingly, monetary bonuses were among the least
effective and most problematic motivational tools used
during this phase of the transformation. The use of bonuses
incentivised operations managers to aim to reduce safety just
enough to earn additional pay, rather than motivating them
to shoot for the much more dramatic improvements that Rio
Tinto executives ultimately hoped to achieve. This experience
is not unique to Rio Tinto: George Akerlof, winner of the
Nobel Prize in Economics, has observed that emphasising
the moral or social importance of organisational change
can often serve as a more powerful incentive than monetary
bonuses. Jim Collins, author of “Good to Great,” makes the
point more bluntly: “incentives are not tied to organisational
greatness; intrinsic motivation and discipline matter more.”
“ABOUT PEOPLE, NOT NUMBERS”
Despite significant improvement, there was still
considerable variation throughout the company. It
became clear to leadership that if Rio Tinto was to
implement safety standards that every single Rio Tinto
site met, then it would need to build a culture of safety.
This would require winning the hearts and minds of Rio
Tinto employees.
“ I say to the leaders, ‘You know, you can’t be there at 2
a.m. on a Sunday to watch over every safety decision. So
you have to have done the work beforehand so your people
make the right decision and they know the consequences
”
of not making the right decision.’7
Individuals had to autonomously, and almost
automatically, choose to follow procedures on their
own. They would only do so if they internalised the
value of those precautions. Rio Tinto’s leadership
therefore concluded that “…time should [be] spent
promoting safety as a corporate value not just as a
priority.”
The company’s leadership leveraged several
mechanisms to convince workers that safety was
“about people, not numbers,”8 which in turn led to the
development of a genuine, worldwide culture of safety.
Organised “safety interactions” forced senior managers
to go into the field and discuss safety issues with
workers at mining sites. This program made managers
understand that safety improvement targets were
about protecting the lives and limbs of the workers
they met, rather than mere bureaucratic compliance.
For workers, too, this provided the sense that safety
standards were intended to save their lives, and that the
managers enforcing those standards genuinely cared
about their well-being.
Rio Tinto also required every individual worker to
develop a “personal safety plan,” a brief reflection on
the risks that he and his colleagues faced, and the steps
that he could take to proactively protect himself and
those around him. At the corporate level, Rio Tinto
required that every meeting start with a “safety share,”
a chance for managers to briefly describe any safety-
related challenge and to receive constructive advice
from colleagues who had resolved similar problems.
Finally, over time, the company proactively promoted
managers who showed a genuine passion for safety.
This resulted in an increasing number of executives that
emphasised safety as a personal, moral imperative.
Taken together, these steps created a culture of safety
at Rio Tinto. As Robert Davies, Chief Safety Advisor
noted:
“ ”Safety at Rio Tinto isn’t about numbers. It’s about
people.
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As they became corporate values, the company also Rio Tinto Injury Frequency Rates

developed a culture of continuous improvement and 5

constant innovation with regards to health and safety.

4

“ There are always areas for improvement and areas to

Number of Workers Injured

watch. But at Rio Tinto, there are not a lot of areas 3

where the foundational elements are not right. The

assurance process is central, but at this point maybe 2

it is less about policing, and more about continuous

improvement.9
”
In particular, Rio Tinto has set out to close the safety
1

gap between developed and developing countries by 0

collaborating with governments, nonprofits, and other

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

stakeholders to go far beyond the legally-required
minimum safety standards in emerging markets. In
2002, Rio Tinto became the first mining company in
All Injury Frequency Rate (AIFR) Lost Time Injury Frequency Rate (LTIFR)
The All Injury Frequency Rate (AIFR) and Lost Time Injury Frequency Rate (LTIFR) are the two main
metrics used to quantify mining companies’ safety performance around the world. The AIFR measures
all of a company’s injuries and other incidents requiring medical treatment. The LTIFR measures only
lost-time injuries, defined as the number of serious injuries that leave an employee temporarily or
permanently unable to work due to disability or death. Both rates are generally calculated according to
200,000 hours worked. Rio Tinto’s safety performance improved dramatically and consistently on both

Brazil to comply with ILO Convention 176—even before metrics. [Sources: Safe Work Australia and Rio Tinto].

the Brazilian government ratified the treaty. Rate of Change, Rio Tinto AIFR
0.3

THE RESULTS 18%

Improvement
10%
Decline
21%
Improvement
14%
Improvement
18.5%
Improvement
Annual Percent Change

0.2

These efforts ultimately led to dramatic and consistent 0.1

safety gains at Rio Tinto. Incident rates declined 78% 0

to 80% between 1998–2006, and continued to drop -0.1

by roughly 15–20% per year from 2006–2010. With the 2006 2007 2008
Year
2009 2010

exception of one outlier year, improvements have been

steady, substantial, and sustainable.
These gains have made Rio Tinto a global leader in
mining safety—a status that gives the company a
distinct competitive advantage in emerging markets. As
CEO Tom Albanese said:
Remarkably, the safety transformation at Rio Tinto has
been so dramatic that in 2009, the European Union’s
Agency for Safety and Health at Work (EU-OSHA)
recognised Naintsch Mineralwerke—the same Rio
Tinto subsidiary that experienced the Lassing disaster
a decade earlier—as the European leader in mining
safety.

“ I find it incredibly powerful that if I meet with the Prime

Minister of an emerging country, I can say that we will
use the same employee health and safety standards as we
Barely a decade after suffering its worst accident in
history, Rio Tinto had become the industry leader in
do in Australia, the U.S. or Canada. It is very hard for mining safety.
someone to compete with that.
”
FROM DISASTER TO DISTINCTION | 8
 The Transformation of Safety Outcomes at Rio Tinto
The Transformation of Safety Outcomes at Rio Tinto

1998 1999 2000 2011

4.0
per 200,000 hours worked
All Injury Frequency Rate

10 people killed in Lassing

0.0

AWARENESS CATALYTIC INITIAL SYSTEMATIC CONTINUOUS

EVENT RESPONSE IMPROVEMENT IMPROVEMENT

• Growing industry • CEO realisation and • Senior leadership team • Learning from around • Best practices are
awareness senior team develop comprehensive group centralised and systematised
• RT adopts No Fatalities communication safety proccedures and synthesised • Safety becomes a
objective • DuPont analysis standards • Focus on behaviours, corporate value, with
• Introduced NOSA • Performance audits not just outcomes emphasis on “people,
• H&S efforts yield only reinforce targets not numbers”
incremental • Outcomes begin to
improvement change significantly
• Core behaviour /
mindset unchanged

INITIAL RESPONSE SYSTEMATIC IMPROVEMENT CONTINUOUS IMPROVEMENT

1 EDICT 2 CONTROL 3 ACCEPTANCE 4 COMPLIANCE 5 COMMITMENT 6 DEDICATION

Senior leadership Senior leadership Managers Operations Leadership uses Rio Tinto develops
mandate implements gradually accept managers comply, several tools to a culture of safety,
company-wide performance that commitment but leadership has humanise safety which spurs
safety standards audits to ensure to safety is not a not yet won over and to frame it as continuous
in response to compliance with passing fad— their “hearts and a corporate value improvement
Lassing. new safty and accept that minds.” and a moral throughout the
standards. Those complance will imperative. company.
who don’t comply be necessary. Managers and
are fired. workers become
genuinely
committed to
keeping each
other safe.

FROM DISASTER TO DISTINCTION | 9

LESSONS LEARNED
The phases and development of Rio Tinto’s safety
transformation were consistent with those of
companies in other high-risk industries, such as
DuPont. More specifically, gains at Rio Tinto generally
followed those predicted by the Bradley Curvea—a
concept first developed by DuPont and transferrable
to safety transformations in many high-risk sectors.
Improvement along this curve usually begins with
awareness, as a company becomes sensitive to the
importance of safety but takes only incremental steps
towards change. Transformation often begins after
a catalytic event—in this case, the Lassing disaster—
and after a period of pushback and resistance, the
company begins to enjoy dramatic gains as new safety
procedures drive systematic improvement. Companies
continue to experience consistent and sustainable
gains as they build a culture of safety and continuous
improvement.
a
Though the intuition underlying the Bradley Curve has
remained the same since first developed by safety experts at
DuPont, different authors have since used varying terminology
to define each stage along the curve. The labels used in this
analysis are meant to be as simple and illustrative as possible.
Like firms in other high-risk industries, Rio Tinto
passed through six distinct micro-stages of change
as leaders fought to overcome initial institutional
resistance in order to reach a genuine, worldwide
cultural transformation. The company’s path began
with the announcement of an edict, as senior leadership
mandated new safety standards in response to the
Lassing disaster. The use of robust performance audits
then enabled senior leadership to exert control over
the safety precautions used at work sites. Acceptance
followed as site managers gradually realised that Rio
Tinto’s enhanced commitment to safety wasn’t going
away, which led in turn to gradual compliance with the
new safety procedures and to systematic improvement
in safety outcomes throughout the company.
Senior leadership built off these early gains by
emphasising that Rio Tinto’s commitment to safety
was “about people, not numbers.” While high-quality
data was crucial for analysing safety performance and
measuring improvement, the message around safety
was not about numbers and compliance, but about
the concrete, human tragedies that safety programs
aim to prevent. A genuine commitment to safety
began to emerge throughout Rio Tinto, and workers
gradually developed a sense of personal dedication to
keeping each other safe as the company developed an
institutionalised culture of safety.
“ The accident figures of Rio Tinto Minerals Naintsch
speak for themselves. At the end of July 2008, the
lost time injury rate for the entire enterprise has stood
at zero for over four years. The underground mine in
Kleinfeistritz has even been accident-free for seven
years and the Weisskirchen Mill had been accident-free
for nine years until the second half of 2008…[Safety
standards] went far beyond the evaluation required by
law…[and workers] identified personally with the ‘zero
”
accidents’ target.
European Union’s Agency for Safety and Health at
Work (EU-OSHA)
The ultimate result was continuous, steady, and
sustainable improvement in safety outcomes around
the world.
FROM DISASTER TO DISTINCTION | 10
Rio Tinto’s transformation into an acknowledged leader
in safety holds specific lessons for any leader seeking to
drive important and lasting change.
Transformation only takes place amidst a
sense of urgency
Rio Tinto was aware of the importance of mining
safety long before 1998, but it took the horror of the
Lassing incident to create the sense of urgency needed
for senior leaders to drive change around health
and safety at Rio Tinto. Of course, managers may not
need to wait for disaster; they could create a sense of
urgency by setting bold and ambitious goals, calling
attention to the implications of seemingly small but
representative cases or data points, or highlighting
the risk of falling behind to organisations in which
transformation is already underway.
Intel, for example, successfully drove a safety
transformation somewhat comparable to Rio Tinto’s
about ten years earlier. “There was no disaster; Intel
was driven by comparative numbers that showed their
performance was ordinary. The culture there is not to
accept that; they asked ‘why are we mediocre?’ and
ultimately changed their performance.”10
comprehensive, company-wide safety standards and
procedures that were practical to implement and went
far beyond legally-mandated safety requirements gave
managers and workers the tools and processes needed
to achieve dramatic gains.
Pushback is natural—but persistent leaders
can overcome it
Managers throughout Rio Tinto assumed that safety
standards were a passing fad that merited neither
serious consideration nor prioritisation. Systematic
improvement occurred only after executives fired
managers who missed performance targets, and paid,
praised, and promoted those who were on target.
Future transformations at Rio Tinto will likely incur
similar pushback—and will lead to significant gains
only if senior leaders show that reforms are not going
away.
Eventually, efforts at change must touch
values that the company’s people genuinely
care about
Rio Tinto executives leveraged incentives to force
compliance and drive early gains in the years after the
Lassing incident, but true transformation occurred only

“ The role of HSE is essential, but not sufficient. The most

important role is leadership. I have seen interviews with
Tom Albanese where the interviewer asks about some
after safety became a core corporate value and a moral
imperative throughout the company. By driving home
the message that safety is “about people, not numbers,”
other topic and his reply is ‘before we begin, let me talk
Rio Tinto’s leadership spurred the company’s people
about safety.’ If he didn’t care, we wouldn’t be where we
worldwide to create and maintain the safety culture
are.11
” that sets the company apart—and that saves as many
people every year as died that day at Lassing.
Urgency isn’t enough

Leaders need to do more than make the case for

transformation—they need to chart a clear and
convincing path forward. Rio Tinto’s creation of

TO GET IN TOUCH WITH THE TEAM AT PROJECT POSITIVE IMPACT, PLEASE EMAIL US: POSITIVEIMPACT@RIOTINTO.COM FROM DISASTER TO DISTINCTION | 11
1. Interview with Kevin McLeish, Global Head of Safety, Rio Tinto,
30 August 2012

2. Interview with Kevin McLeish, ibid

3. Interview with Robert Davies, Chief Safety Advisor at Rio Tinto.

March 1, 2012.

4. Interview with Robert Davies, ibid.

5. Interview with Kevin McLeish, ibid.

6. Interview with Robert Davies, ibid.

7. Interview with Kevin McLeish, ibid

8. Interview with Robert Davies, ibid.

9. Interview with Kevin McLeish, ibid

10. Interview with Francisco Benavides, General Manager HSE,

Rio Tinto Copper, 28 February 2012.

11. Interview with Francisco Benavides, ibid.

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